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Problems with ER

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ReggieN ReggieN (New) New

Specializes in cardiac/telemetry. Has 2 years experience.

We've been having issues with the ER in our hospital. I work on a busy telemetry floor and when the ER calls up to give a report on a new admission, if the nurse taking the patient is unable to take the call right away, our ER sends the patient up without giving report. I've spoken with the nursing supervisor regarding this and he said that's just what they do, but quite honestly, this doesn't seem safe or legal. Any insights would be appreciated

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

In my state what you describe is illegal since it's patient abandonment. It would be legal so long as the nurse caring for the patient comes up with the patient and continues to care for the patient until they've transferred care to another nurse by giving them a verbal report, which is what's required in my state.

EmergencyRN22

Specializes in Emergency Room.

It's not safe. Is your point person or charge able take report and relay the info for you?

RyanCarolinaBoy, ADN, BSN, MSN

Specializes in ICU. Has 15 years experience.

Perhaps the ER is tired of playing the "I can't take report right now" game that so many floors seem notorious for. It gets old. I work both inpt and ER. I see both sides.

Maybe you can have a nurse who floats the unit assisting other nurses, and that would be your admissions nurse for the shift. Backed by the charge nurse if there's more than one admission and they are coming fast and furious.

A nurse can not just come up with a patient and leave them without some type of report. Nor can they send up a patient with a transporter and just have them show up.

This is a patient safety issue. And I am curious what your risk management department would say regarding this. And that is who I would report this to.

nursej22, MSN, RN

Specializes in med/surg,CV. Has 30 years experience.

This is an age old issue but IMO the root cause is understaffing: the ED is forced to push people out as their frantic schedule allows, and the floor nurses are always doing something that can't be easily interrupted.

And who suffers the consequences?

ReggieN

Specializes in cardiac/telemetry. Has 2 years experience.

That's been part of the problem with our floor. We are terribly understaffed and overwhelmed and when we've tried explaining this to our ER they say tough. I am concerned though about patient safety. I don't feel that it's right for the Er to just send a patient up without giving a report. Are there any suggestions on how this should be handled, to make it safe for the patient

Have you tried completing incident reports when the protocol for nurse to nurse report is breached and the patient is left in an unsafe situation on the floor?

imintrouble, BSN, RN

Specializes in LTC Rehab Med/Surg. Has 16 years experience.

. It's one thing that all the nurses on the floor agree on. We stand together on this issue so it's harder to antagonize us, than to pacify the ER.

Stalling is also not done. None of us would support a nurse who didn't take report in a timely manner.

Fair is fair.

Altra, BSN, RN

Specializes in Emergency & Trauma/Adult ICU.

If this is occurring with regularity, and doesn't seem to ruffle the feathers of your unit management, then this was a conscious decision for a change in process that your unit management is fully aware of. If this was not communicated to your staff, an important opportunity for education and collaboration has been missed.

Think about it: can the ER, or any other unit, unilaterally implement a change like this without some buy in from higher management?

Our policy is if the admitting nurse can't take report right away then the charge nurse has to. They will absolutely not send the patient up without report.

Like it has already been said, this is an age old issue. I'm coming from an ER point of view, and in our hospital, we give one phone call to attempt report, either to the RN or the charge. If there is no one able to take report and the bed is ready, we fill out a paper report and the patient goes up. The nurse is free to call at any time to get report after the patient goes up. Never have I sent an unstable patient to the floor, and usually most of my inpatient orders have been started (can't speak for other nurses on this one).

The biggest difference between the ER and floors is that there is such a vast difference in priorities. You are correct in saying it is a patient safety issue. However, in the ER, we don't get to choose how many patients we get and what acuity they are. If we are pushing people onto the floor, it is usually because we want to avoid running traumas/strokes/codes in the hallway… Which is, as you might imagine, a patient safety issue. In the ER, our focus becomes on patient flow… Either discharge or admit the current pt so we can get the diaphoretic chest pain out in the waiting room & in front of a doctor. I don't deny this problem stems from the ER but I also hope to shed some light on our perspective.

All that being said: I do not feel that sending a patient with no report or attempt at report is adequate. I would definitely look into ways to improve this hand off process. Leadership usually responds to staff that not only broach a problem but also offer options to solve it. Maybe bedside report would work better for your organization or maybe some sort of paper SBAR and a quick "Do you have any questions" conversation (for the stable pt) would be better. Just thoughts on what I've seen work before.

eroc

Specializes in CVICU. Has 2 years experience.

Policy at my hospital has been unless they are going to the ICU they don't have to call report. And a ER nurse only escorts a patient up if they are on a cardiac drip.

It has worked well and I see no problem with it. They are going from critical care to acute care. If they are A&O just ask the patient, and look at the chart. I have never had one issue when working on an acute floor.

trinitymaster

Specializes in Long Term Acute Care, TCU. Has 16 years experience.

I am so glad to now be working in a facility without an ER. ER is horrible. The Managers want them to have a one-hour turn around which is nearly impossible. There are core measures. The charting systems neither communicate nor reconcile with each other. Too many brand new nurses. Focused assessments where the 103 temp is attributed to bad food and not to the osteomyelitis that the patient did not mention.

The floor is dangerously understaffed and no one wants to take report, especially from an ER tech who has never seen the patient and is only reading off of a report sheet.

Both sides are completely stressed to the limit and sometimes it puts them at each others throats.

Neither side is to blame, they just learn to cope in their own unique way.

trinitymaster

Specializes in Long Term Acute Care, TCU. Has 16 years experience.

Never have I sent an unstable patient to the floor, and usually most of my inpatient orders have been started (can't speak for other nurses on this one).

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I would just settle for my ER sending me stable patients. They recently sent me a patient at shift change: 207/100 BP. We are not a cardiac floor, and have to call intervention to deal with crazy cardiac -ish like this. Thanks ER.

PacoUSA, BSN, RN

Specializes in PCU / Telemetry. Has 8 years experience.

We get patients from the ER without report all the time, it's actually the standard practice at the hospital I work at right now (one of the top 10 hospitals in the country per US News & World Reports). I haven't had a problem so far, patients are always relatively stable when they arrive. I suppose the ER makes sure to not send them until they are. I've worked at another hospital (not nationally ranked) where the ER called the floor for report and I always found it a hassle. The ER nurses there always reiterated to me the same details I could read on the EMR from upstairs, so for me it was a waste of time, and they rarely offered info not in the chart, such as neurotic family member at bedside coming up with patient. They also often tried to send patients up that clearly belonged in higher care. I like it better where I am now. Shame tho, as I am a traveler and moving on to another hospital in about a month, hopefully they also have no-report transfers from ER.

Sent from my iPad using allnurses

We've been having issues with the ER in our hospital. I work on a busy telemetry floor and when the ER calls up to give a report on a new admission, if the nurse taking the patient is unable to take the call right away, our ER sends the patient up without giving report. I've spoken with the nursing supervisor regarding this and he said that's just what they do, but quite honestly, this doesn't seem safe or legal. Any insights would be appreciated

Reading between the lines, it sounds like your hospital is trying to reduce ER throughput times, and that delays in giving nurse to nurse report have been identified as a factor. I agree that no handoff report is a patient safety issue- have you spoken with your manager? Could the charge nurse take report if the primary nurse is unavailable?

What others have said is true. Throughput times are a huge focus at my facility right now. The moment they have a bed and a nurse, they are supposed to roll. The receiving nurse is expected to look the patient up in the EMR, and the telephone report is just a quick conversation to cover anything not in the EMR (like the neurotic family member). If the receiving nurse cannot take report, then the charge nurse does.

Sometimes I feel badly, especially when there are several admits, like we're just cramming patients down their throats up on the floor, but it is the directive we have received, and is supported by administration, the house supervisor, our manager, and the manager and charge nurses on the floor. Getting them rolling with minimal delay is what we are supposed to do.

Could it be that's the case at your facility and nobody has bothered to inform the floor nurses of this?